Barton, Maude S .i
TO'J4'W OF QQLVEWB l..lR
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director j hy't N d3Rc t
Name ,4 fieD, .�,9RT tt Case #
Date of Cremation f// -' 02c70
Tire Cremation Started /9-,fr1 i
Time Cremation Comoleted, rjf ,/24/
Type of Container .R/#4Yc1,Q"7-y GJ95XET c2/ O,
Remarks :
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TOWN OF QUEENSBURY
PINE VIEW CEMETERY
CREMATORIUM
Quaker Road. Queensbury, New York 12804
Phone (518) Crematorium 745-4477 (if no answer)
Cemetery 745-4476
•
AUTHORIZATION TO CREMATE
The undersigned requests and authorizes Pine View Crematorium, in accordance with and subject
to its Rules and Regulations to cremate the remains of:
Maude S. Barton Female
(NAME) (SEX)
Town of Saratoga
100 Hill Street Box 33 Victory Mills, NY 12RR4
(STREET) (CITY) (STATE) (ZIP CODE)
who died on 16th day of June 20 02
at 100 Hill Street Box 33 Victory Mills, NY Town of Saratoga
(PLACE) (ADDRESS)
Name and address of nearest living relative or name of person authorizing cremation:
Robert I . Brown 100 Hill St Box 33 Victory Mills, NY 12884
Relationship to deceased Son
Name of Funeral Home Flynn Bros. , Inc. Schuylerville, NY
IMPORTANT
I represent that to the best of my knowledge, the deceased has or has no pacemaker in his or her
body. (CIRCLE ONE)
I certify that I have the full power and authorization to arrange for the cremation of the remains and
to direct the disposition of the cremated remains, that any personal possessions have either been
removed or may be destroyed, and agree to protect, defend and save harmless Pine View
Crematorium from any and all claims and demands for loss or damages which may be made
against them by reason of or connected with the cremation of said remains as directed, whether
claims or d and w y groundless, false or fraudulent.
13 Gates Ave. Schuylerville, NY 12871
( ITNES ) (ADDRESS)
� Box 33 Victory Mills, NY 12884
(SIGNATURE OF RELATIVE OR LEGAL REP. AND ADDRESS)
Signed on this date: 6-17-02